Donor and Recipient Sex Matching and Corneal Graft Failure in High-Risk and Non-High-Risk Patients.

Purpose: It is controversial whether donor-recipient sex mismatch is a risk factor associated with corneal graft failure. The purpose of this study was to investigate the effect of sex mismatch on corneal graft failure in high-risk and non-high-risk patients.

Design: A retrospective study.

Methods: The medical charts of patients who underwent corneal transplantations by one surgeon between 2012 and 2017 were reviewed. Patients were defined as high-risk for failure if they had glaucoma, ocular surface disease, or corneal vascularization. Graft failure rates were compared using the Kaplan-Meier survival curves between sex matched and mismatched subjects and between male-to-female grafting and other patients.

Results: One hundred and thirteen patients with a minimum follow-up of 18 months were included. In 62 non-high-risk patients, graft failure rates were similar between the sex mismatched and the sex matched recipients (=0.645, log-rank) and in male donor to female recipient transplantations and in the other transplantations (=0.496, log-rank). Analysis of fifty-one eyes of 51 high-risk graft recipients (mean age of 73.4 ± 12.7 years,  = 26 females) showed that graft failure rates were significantly higher in the sex mismatched than sex matched recipients (=0.022, log-rank) and in male donor to female recipient transplantations than in the other transplantations (=0.002, log-rank).

Conclusions: Sex matching for every patient bares logistic difficulties; however, in patients who are at high-risk for graft failure, it may be a simple way to improve outcomes and better utilize corneal grafts.